1457699100 NPI number — ABBEVILLE DENTISTRY- ODESSA PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457699100 NPI number — ABBEVILLE DENTISTRY- ODESSA PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABBEVILLE DENTISTRY- ODESSA PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457699100
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2631 FAUDREE RD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
ODESSA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79765-8526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
432-301-9838
Provider Business Mailing Address Fax Number:
432-563-1763

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2631 FAUDREE RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ODESSA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79765-8526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-301-9838
Provider Business Practice Location Address Fax Number:
432-563-1763
Provider Enumeration Date:
01/30/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ARMSTRONG
Authorized Official First Name:
KATHIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF CREDENTIALING
Authorized Official Telephone Number:
502-254-8501

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com